Wonder if this will ever break through into his consciousness

Let’s be clear that I am not excusing either party for its haplessness: incompetence is unappealing from wherever it comes and right now it is being offered by the two major party leaderships in Westminster. But if that is the case and continues, as seems likely, what are the prospects?

We’re ruled by idiots and yet obviously politicians should have more power over our lives.

What point the Curajus State if they’re all cack handed morons?

The demand that GPs provide a seven day a week service is one they simply cannot meet: there are not enough GPs to do it. And unlike the junior doctor dispute, no one will die if a GP is not open on a Sunday. Emergency health care of a very high quality is already available seven days a week in the UK. This demand from the government is simply about consumer choice, not medical need. So GPs need to say no.

Which is all you need to know about what the populace wants in said Curajus State really, isn’t it? “Simply” consumer choice?

48 comments on “Wonder if this will ever break through into his consciousness

  1. I don’t want to go to the bloody doctor’s on a Sunday. They can bloody well open normal hours like everybody else.

  2. We already have GPs available in many areas 7 days a week. The local walk in clinic.
    If you don’t have anything else to do for 3 or 4 hours you can see a doctor.

  3. Plenty of GPs already work “out of hours” on Sundays and at weekends, including home visits, and are very well paid for their trouble. Simply a question of supply and demand.

  4. Wasn’t there someone in the Grauniad a couple of days ago bemoaning the fact that her dog has better access to its vet than she does to her GP?

  5. I was going to point out the excellent Ironman has said that Murphy’s vision is all about the ‘Producer’s interest’ (and he was first to the punch here!) – never the consumer. A generous interpretation of his vision is that he is advocating something like Perestroika era communism in the USSR or maybe even contemporary Belarus (cappucinno communism) – I veer towards being less generous and calling it as advocating policies that will culminate in North Korean style command economy.

  6. Yes, it always amazes me; Murphy loathes every British government for the last 37 years (with the possible exception of the two and a bit years of the Brown Ministry), yet wants government to have more power.

  7. I must be missing something here, because it really doesn’t seem too tough to deliver.

    Couldn’t the GPs just work rotating shifts? Work a 5-day week, but one of the several docs at the practice takes a couple of weekdays off instead of the weekend?

    (unless there aren’t several GPs at a practice, of course)

    Seems to me like the only real obstacle would be that GPs only want people to be ill when it suits their preferred working pattern, so they won’t agree to do it.

    PS: not sure of the practicality, but I’d like to somehow see the weekend slots reserved for people in employment.

  8. Concentrated benefits and diffuse costs. Most of the so-called crises in public service provision in the UK and elsewhere are a producers’ ramp. Murphy knows what side his bread’s buttered; he has low cunning in this area even if he is wildly dim everywhere else.

  9. “her dog has better access to its vet than she does to her GP?”

    Then she should don a dog costume and visit the vet.

  10. The supply of doctors (and presumably ultimately therefore GPs) has in recent times been restricted by the BMA, with the connivance of the government.

  11. Cynic

    I really don’t care what bloody shift pattern they work. I do care that the consumer wants a 7 day a week service, pays a shitload of tax and so should get a 7 day a week service.

    And if jgh doesn’t want to see his doctor on a Sunday he should be free to see them on another day of the week – but not tell me when I can see my doctor.

  12. The vet vs doctor thing is very instructive:

    A friend’s cat was poorly over Christmas. She rang the surgery on Boxing Day, there was no-one there, but a recorded message said they would be open the next day (a Bank Holiday still) and there was an emergency number to call if needed. She decided it wasn’t an emergency and went the next day, when she saw a vet and got immediate treatment for the cat.

    Over the similar period my Father (who is blind and housebound, having 24/7 nursing care at home) was not well and my Mother wanted a doctor to see him. She rang the surgery on Boxing Day too. There she received no message, just that the surgery was closed. No date for reopening, no emergency contact number, nothing. After several days of chasing a doctor deigned to come and visit, and was to be fair very apologetic, given my Father’s condition was not good and needed immediate antibiotics. But the whole process was a nightmare.

    I have had need to call vets at all hours of day and night and have always received excellent service – once having to take a dog in with severe lacerations to its chest where it had run into something sharp, at about midnight on a Sunday. The vet met us at his surgery and treated the dog there and then, and operated first thing in the morning, and the dog was home by Monday evening. Its amazing what the free market system can provide.

  13. Ironman,

    “I really don’t care what bloody shift pattern they work. I do care that the consumer wants a 7 day a week service, pays a shitload of tax and so should get a 7 day a week service.”

    OK, customer right and all that, but what’s the benefit? In fact, generally, what’s the point of GPs?

    I went to mine because of something on my balls. It was referred to someone to examine my balls (fine as it turned out). What did that save over me walking into the ball examination clinic?

  14. Cynic sounds about right; it shouldn’t be difficult to have doctors all working different shifts so that there is seven-day coverage but each one only works five days a week.

    And it’s a more efficient use of physical assets. For example four doctors each working Monday to Friday need four equipped consulting rooms, which are unused for two days a week; but if the same four doctors are each working five different days out of seven they only need three consulting rooms between four.

    That’s a 25% saving in capital expenditure and premises costs (OK, not quite, as there will already be some shared equipment and space, but there’s certainly big savings to be made).

    And that gets more important as they have more, and more expensive, physical equipment.

    But isn’t Murphy’s wife a GP? Is he just using his blog to argue for his wife to have weekends off.

  15. Biw

    GPs exist as a gatekeeper/ generalist to try to direct customers to the right specialist. What if the ball thing was a sign of something else. Yes, a lot of the time it doesn’t work, but beats having specialists swamped.

  16. One of my pet peeves is that standard opening hours for businesses like this, including GP surgeries, is that they always seem to be open when everyone is at work or school and not when most people would actually be able to use them. Banks are also some of the worst offenders. Is it really that fucking hard to be open say 7-9am, Midday-2pm and 5-9pm rather than 10am-4pm? Plus employ people to work on weekends too, including proper (i.e. full) hours on Sunday.

    Also as mentioned above by CS there is an artificial restriction on numbers of physicians, which I personally first noticed by back at sixth form when I saw very bright (straight As) fellow students be rejected from university after university for medicine as courses were full. Can we cut down on media studies courses etc. and funnel all that cash to medicine instead?

  17. Recently, I needed to talk to a GP as a gatekeeper for a specialist.

    As the consultation did not require any fingers to be inserted into any arses, it was done as an internet video call on my phone. This meant the 15 mins or so it took could easily be fitted into normal working time without a problem.

    It depended on the doctor keeping to the appointment schedule. Which he did.

    Very efficient, user- and employer-friendly.

    You’ve guessed it: private health care provider.

  18. I agree with Richard (3:31) about the saving in facilities costs.

    It’s not as though all of them work every weekend.

    I’m retired, so when seeking a doctor’s appointment I make a point of asking for an appointment that won’t get in the way of people who work – then I face the blank looks from the receptionist.

  19. Despite having several reception staff, my local NHS surgery reception shuts down from about noon till 2pm.

    Yep, they apparently all go on an extended two-hour break at the same time.

    Said break also happens to coincide with that time during the day that most working folks are on their lunch break and are free to phone up for an appointment.

    Their practice website has a link to a new online appointment booking system. Last time I followed it, this link took me to a page that told me their surgery doesn’t offer online appointment booking.

  20. Richard,

    “Yes, it always amazes me; Murphy loathes every British government for the last 37 years (with the possible exception of the two and a bit years of the Brown Ministry), yet wants government to have more power.”

    As Murphy hadn’t published The Curajus State they can’t have been following its strictures and therefore must have been incompetent.

    Brown came close but didn’t follow through with ennoblement for Murphy, which is why he failed.

    In his eyes the only way to have a competent State is one in which follows his book and has him in the Government as the general enforcer of those rules.

  21. I’m fairly impressed with the NHS since we moved back down here. GP appointments booked on line and if no visit needed ie to discuss something in general, they will ring us. Repeat prescriptions on line and delivered to the village shop.

    A minor injuries clinic open 8am to 10pm days, albeit some distance away, for first aid that can’t be self administered and a separate emergency system for real emergencies operating 24 x 7.

    When I needed an xrays my GP printed out the letters while I waited, I just just turned up in the afternoon with the letter and it was done on the spot. (They prefer you to turn up in the afternoon, but not mandatory). I think I waited 15 minutes the first time and 30 minutes the 2nd time, and that was because the Consultant checked it on the spot.

    When I had a one off case of blood in my urine I rang the doc in the afternoon when it happened, saw him at 9 am the next day (Friday) and by CoP Monday I had spent all day in the hospital as an outpatient, loads of tests finishing up with the old camera inserted.

    But then we’re staunch Tory round here so everyone just gets on with implementing reforms rather than spending time and money protesting about “privatisation of the NHS”.

    So different from South Bucks where I lived before.

    Given all that I really don’t see the need for 7 day GPs but won’t argue against them.

  22. CS,

    Thank you for letting me know that the BMA is a big piece of the problem. I have been too lazy to find out if it was the trade guild or socialism, through wage controls, that was causing your lack of doctors. 2.8 doctors per 1000 people simply isn’t enough.

    Unless there are over 3, probably closer to 3.5, per 1000 one simply doesn’t want to visit the GP stuck working weekends anyway. The good ones with experience will end up picking a regular work week.

    Note: In the US the problem is the AMA. We have only 2.5 doctors per 1000 which explains the ridiculous, compared to the rest of the world, salaries.

  23. Ken,

    “GPs exist as a gatekeeper/ generalist to try to direct customers to the right specialist. What if the ball thing was a sign of something else. Yes, a lot of the time it doesn’t work, but beats having specialists swamped.”

    But how good a system is that when GPs themselves are very expensive, probably more expensive than the nurses who checked my balls?

    And we don’t apply that everywhere, do we? You don’t go to your GP with toothache, or to get your eyes checked. You go to the dentist or optician.

    Opticians are the model we should try and learn from – people trained to a level to do the routine stuff, to act as those early gatekeepers. Lots of capacity out there as a result, but at the same time, they’re detecting various conditions (and just to add – GPs are woeful for how little technology they use).

  24. Its pretty pointless GPs being the ‘gatekeepers’ to the NHS if they only operate 10 hours a day for 5 days a week is it? Thats why A&E are rammed full, because people outside those hours can’t get to see a GP and go to A&E instead. The whole point of GPs was that they were supposed to keep people away from hospitals unless it was 100% necessary, and that meant operating a 24/7 service, which is what GPs used to do.

    But of course they’re too big and important to do that any more of course.

  25. Restricting supply of medical school places is obviously a nice little earner for the medical profession – you’d think the left would have taken on the ‘middle class scum’ at the BMA by now. Oh – sorry I forgot the unholy alliance that rules this out, because NHS.

    Where best practice (excuse the pun) re appointments is implemented standard GP surgery hours with out of hours cover can work well. That’s as long as the GP isn’t one of the many that seem to assume only wasters who’ve nothing wrong with them book appointments…

  26. “her dog has better access to its vet than she does to her GP?”

    Let me guess – her vet charges *her* per-appointment?

    Here in Ireland, its 50 Euro to see a GP (lots of people have cards which allow them free visits). It’s very easy to get a GP appointment – call in the morning, get an appointment later that morning or same afternoon.

  27. BiI: Many other countries with good healthcare systems seem to operate a small payment per GP visit system. Pick a price point that puts off any time wasters whilst not restricting GP attention for those who actually need it. Or have some form of fee repayment if it turns out you had some serious illness. Simple enough to administer and solves a hell of a lot of the problems in NHS primary care

  28. @Jim, January 3, 2017 at 3:25 pm
    “The vet vs doctor thing is very instructive:”

    Indeed it is.

    Vet: Take unwell dog to vet, blood sample taken. Nurse takes it away. Vet examines dog and talks to owner about symptoms. Nurse returns with print-out of blood test analysis. Been like that since late ’80s at Vet I use.

    GP: see GP. He wants a blood sample. Make appointment to see nurse some day in future before whatever time blood samples collected at that practice. Twiddle thumbs and suffer. Eventually sample taken. A few days later GP sends a letter and asks you to make an appointment to discuss blood results.

    Why, 20-30 years after most Vets (and even PDSA) have had blood analysis machines in their practices do GPs still not?

  29. As of December, 51.7% of GPs were women. And women either want to work part-time or they want to work ‘family-friendly’ hours. This is in part why GPs are reluctant to offer a 7-day a week service.

  30. It costs me about $25 for a private consult. Procedures that need expensive machinery and/or a technician are extra, but fairly cheap (a cranial CAT scan is about $150, and abdominal ultrasound about $80). It works.

  31. Jim said:
    “GPs … only operate 10 hours a day for 5 days a week”

    Wow, where do you get such good service?

  32. Ritchie seems to believe the State should provide what people need, not what they desire.
    So perhaps he’d like the NHS to be cut back to just A&E, communicable diseases and under-18s, with the rest being put on an insurance model. And education to be free up to aged 13, no public lending libraries and no micro-management of peoples lives through timed winter payments. He could be on to something.
    More likely he’s just seeing the world through his own specs – he’s got a GP for a spouse, if she’s not around on a Sunday then he can recite his symptoms to one of her workmates over roast dinner as people do when there’s a gathering with one of the 2.5 per 1000 present. So what he doesn’t need, nobody else needs.

  33. Bongo said:
    “Ritchie seems to believe the State should provide what people need, not what they desire.”

    Not quite. Murphy thinks the State should provide what Murphy thinks they should have.

    And that nothing else should be available.

  34. My GP surgery is open from 8 to 9 Monday to Friday and 9 to 12 on weekends and public holidays. They charge a little bit extra for seeing them after 5pm and at weekends but it is only $10 or so. Kids appointments are free provided that at least one parent is enrolled there.

    The surgery is modern, with a pharmacy, physio and radiography on site, as well as a couple of small operating tables for minor surgery.

    They also have a deal with the 24 hour surgery up the road where we get discounted out-of-hours treatment.

    But then this is what you get when you have a business that operates for profit and thus is incentivised to compete for customers.

  35. I think Theophrastus nails a very important point – while the idiot Blair certainly gave the GPs the opportunity to knock 24/7 care on the head, indeed gave them the financial incentive to do so, its the relentless rise in female GPs thats accelerated that process. And its a process that will only continue as increasing numbers of women qualify as doctors.

    The entire NHS has become feminised and on that criteria alone is doomed to failure (there’s other reasons too of course). Female dominated organisations always end up failing as woman are incapable of working together in the long run for a common shared goal.

    I would put it down to the way our ancestors acquired food – men learnt very quickly you kill more animals by working as a team and sharing the proceeds than by trying to hunt alone. Whereas female foragers gained little advantage from co-operation, indeed if you found a good spot you’d be best off not telling anyone else and making the most of it yourself.

  36. “Why, 20-30 years after most Vets (and even PDSA) have had blood analysis machines in their practices do GPs still not?”

    Because the analytes cost somewhere between £10 and £50 per sample depending on what you want to measure. And the machine costs around £10k, maybe less if the NHS buys lots of them. The vet charges this to the pet owner.

    GPs pay about £3 per patient to send bloods to a lab. GPs receive fixed payments from the NHS per patient per year with bonuses for meeting various targets determined by “health commissioners”.

  37. Its in the vet’s financial interest to get the results quickly and recommend a course of action – may not be the right action but you pay regardless. But need to have the pet seen to and if necessary kept in for treatment.

    Compare that to humans who crowd into GP surgeries. How many patients can one GP see in a normal working day? 30? 35?
    Here in our village the local surgery is quite modern, built just 17 years ago and expanded twice since, with pharmacy on site. The surgery also runs the new surgery built in the next village over so can choose to have appointment in either place if willing to travel. About 10 buses an hour go there from 50 metres from our village surgery.
    We have, last I looked, around 8 GPs plus usually a locum or two. So say 20 – 30 a day each, 8 GPs can see 160+ people a day.
    Call it 15,000 population they are drawing from. Is 160+ people a day too few?

  38. john – what other people do they see in the surgery?
    People needing a prescription that the doctor won’t issue without seeing them.
    People needing reassurance
    People needing referring on
    People needing a sick note
    People asked to come in by the doctor / NHS

  39. Martin, you missed out the people who are obeying the NHS-funded radio adverts telling them that they must see a doctor if X happens to them.

  40. @John, January 3, 2017 at 11:51 pm
    “Because the analytes cost somewhere between £10 and £50 per sample depending on what you want to measure. And the machine costs around £10k, maybe less if the NHS buys lots of them.”

    I’m having difficulties with this. Vet owns machine and runs test on sample. How does the analysis cost Vet £10 – £50?

    OK, machine uses some elec and paper etc, where does the up to £50 expenditure on (I assume) consumables come from?

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